[Congressional Record (Bound Edition), Volume 158 (2012), Part 3]
[Senate]
[Pages 3562-3567]
[From the U.S. Government Publishing Office, www.gpo.gov]




                              HEALTH CARE

  Mr. JOHNSON of Wisconsin. Mr. President, I wasn't here when they 
passed the Patient Protection and Affordable Care Act. This week will 
mark the second anniversary of what I call a very Orwellian name for 
that piece of legislation because I personally do not believe it is 
going to protect patients, nor do I believe it is going to improve the 
affordability of our health care system.
  The reason I ran for the Senate was primarily because of this law. I 
certainly recognized how it was going to result in a lower quality of 
health care, how it was going to lead to rationing, and how it was 
going to severely limit the amount of medical innovation we enjoy in 
this country. In particular, I was offended by the political process 
demonizing doctors and health care providers, demonizing the health 
care system in order to pass this health care law.
  The reason that offended me is a very personal story. It has to do 
with my daughter who was born with a very serious congenital heart 
defect, her aorta and pulmonary artery were reversed. So her first day 
of life, the doctors--who President Obama said would take out a set of 
tonsils for a few extra dollars--saved her life within the very first 
few hours of life. Then, 8 months later, when her heart was only the 
size of a small plum, another incredibly dedicated and incredibly 
skilled team of medical professionals totally reconstructed the upper 
chamber of her heart. Her heart operates backwards now, but she is 28 
years old and now she is a nurse herself in a neonatal intensive care 
unit and she is taking care of those babies.
  So when they passed the Patient Protection and Affordable Care Act, I 
knew the health care system that saved my daughter was at risk. I also 
knew this health care law was in no way, shape or form going to reduce 
our Federal deficit. It is just not possible. How can we expect to add 
25 million people to government-run health care and reduce the deficit 
at the same time?
  The reason they were able to put forward that fiction is they 
proposed a piece of legislation that would have revenue, fees, taxes, 
and penalties for 10 years, while at the same time only providing 
benefits for the last 6 years of that time period. Basically, what they 
did was to say we will raise revenue for 10 years of about $1.1 
trillion, and we will have 6 years' worth of cost, a little under $1 
trillion. That was the fiction.
  Half of that revenue generated is going to be in taxes, fees, and 
penalties. Personally, by increasing taxes and increasing fees on 
things such as medical insurance, on medical devices, and on 
pharmaceuticals, I don't see how that bends the cost curve down. It 
would not bend the cost curve down. It is the same logic this President 
has used when he is talking about high gasoline prices. He says by 
increasing taxes on oil companies we will reduce the price of gas. It 
is just not possible. Increasing fees on providers, reducing 
reimbursement rates to providers is not going to bend the cost curve 
down. It is basically not going to happen.
  The other half of the pay-fors--the other half of that $1.1 
trillion--was proposed reductions basically in payments to Medicare 
providers. Congress, I would say wisely, has not enacted the 
sustainable growth rate cuts to providers because they realize, if they 
do that, access for seniors to medical care will be reduced. I don't 
see how, if we reduce Medicare by $529 billion, that same access also 
would not be reduced. From my standpoint, I think it is highly unlikely 
Congress will actually enact that $529 billion worth of reductions to 
Medicare. When they do not do that, the $143 billion reduction in our 
deficit, that fiction, will totally go away.
  Another reason for that fiction being exposed is because, 
fortunately, Congress realized the CLASS Act portion of ObamaCare 
simply wasn't going to save the money they said it was going to save. 
It simply wasn't sustainable. Budget Committee Chairman Kent Conrad 
actually called the CLASS Act a Ponzi scheme. So this administration 
has decided not to move forward with its implementation. In doing so, 
that is removing $70 billion of revenue from that budgetary fiction.
  I know Senator Kyl has been following this very carefully, in terms 
of what is going to happen to our Federal budget, and I am wondering if 
Senator Kyl would want to comment on how he sees the real effect of the 
health care law on the Federal budget and why

[[Page 3563]]

that is not going to save us $143 billion in the first year and 
probably result in far greater costs to the Federal Government if this 
thing is actually implemented.
  Mr. KYL. Mr. President, I would say my colleague from Wisconsin is 
absolutely right. Let me first of all say, millions of citizens around 
this country have gotten engaged for the same reason as my colleague 
did; as a normal citizen, running his business, he saw what was 
happening here and he decided to get involved. Not everyone can run for 
the Senate successfully and come back to Washington to bring that 
message from America right here to the Senate Chamber, but he has done 
it, and I commend him for his leadership.
  Yes, he is absolutely right. It turns out that his predictions and 
those of us who were on the Senate floor when this bill passed into law 
saying it was going to cost a lot more than our Democratic friends 
said; that it was going to cost a lot more than the Congressional 
Budget Office estimated, well, now the numbers are in and here they 
are.
  The nonpartisan Congressional Budget Office last week just released 
its updated figures, and it shows that the real cost of the ObamaCare 
subsidy spending is going to almost double. When ObamaCare was passed, 
they estimated the cost would be $938 billion. That is on the Medicaid 
part as well as the taxpayer-funded health insurance subsidies. As my 
colleague said, that is a 10-year cost. Of course, part of the game is 
that they are collecting money over 10 years but only paying benefits 
over 6 and that can make it look pretty good, as my colleague said. But 
it turns out, when CBO had to reexamine, now with 2 years' experience, 
what they found is, looking at the entire 10-year budget window, the 
true size of this cost was masked. Now that we have a clearer picture, 
voila, CBO says the projected amount is $1.7 trillion over 10 years. In 
other words, ObamaCare is going to cost more than $700 billion more 
than CBO estimated at the time the law was passed.
  How can they miscalculate by almost double, from $938 billion to now 
$1.7 trillion? It is not CBO's fault. CBO is a bunch of accountants. 
They take what we give them and do their figuring. As the Senator from 
Wisconsin said, what the Senate Democrats and the President gave them 
was just part of the picture. They said: We are going to give you 10 
years' worth of revenues, but we are only going to give you 6 years' 
worth of expenses. See how that works out. I wish we could all do our 
private budgets at home that way.
  Here is another way to look at it. We have all heard of a mortgage 
with a bubble payment at the end. That is, in effect, what this was. 
They basically said: Look, we know CBO has to estimate 10-year budgets, 
so we have a great idea on how to make this cost less. We will put some 
of the big expenditures in years 11 and 12. Voila, 10 years of 
expenditures, not too bad. But now that 2 years have passed and we are 
now looking at a 10-year budget that goes out 10 more years from now--
12 years from when ObamaCare was first calculated--it turns out when we 
add in years No. 11 and 12, it adds hugely to the cost--$700 billion 
worth.
  We all said this at the time. It was a trick. It was smoke and 
mirrors. They were pulling a fast one on the American people. We said 
that. But we heard: Oh no. You can trust CBO. Sure, we could trust CBO 
as far as they could calculate it. But if one had said, how about years 
11 and 12, they would have had to say: That is another story, but we 
weren't asked about that.
  I say to my friend from Wisconsin, he is exactly right. Now the 
chickens have come home to roost. Now we know what the real cost of 
this is going to be and, oh, by the way, if we want to go out over the 
entire period once the law is fully implemented--remember, ObamaCare 
has not been fully implemented yet. So what happens when we calculate 
its full cost when truly implemented? The Budget Committee, on which 
Senator Sessions sits, says total spending under ObamaCare will reach 
$2.6 trillion. So these are the real costs we have to pay attention to, 
not just the estimates that were made at the time they were trying to 
get the law passed.
  I might either ask the Senator from Wisconsin or our ranking member 
on the Budget Committee, what about this? If we use real numbers and 
real costs, are the American taxpayers going to be on the hook for 
something akin to $2.6 trillion, according to the Budget Committee? 
That is a lot of money.
  Mr. JOHNSON of Wisconsin. I wish to point out, the numbers Senator 
Kyl is talking about are CBO projections, just using a different 
timeframe. That isn't even taking into account what I have been talking 
about is an even more significant risk to the deficit, and that is one 
particular CBO estimate that says, on net, only 1 million Americans 
will lose their employer-sponsored care.
  There are 154 million Americans who get their employer-sponsored care 
from employer-sponsored plans. To assume that only 1 million people 
will lose that coverage and get forced into the exchanges is absurd, 
particularly when we have a study by a very reputable firm, McKinsey & 
Company, surveying 1,300 employers, which said 30 to 50 percent of 
employers plan on dropping coverage and having their employees go into 
the exchanges. It is pretty easy to understand why that might happen. 
Right now, the health care law is 2,700 pages; there have been another 
12,000 pages of rules and regulations. So employers looking at the 
health care law are looking at, Do I try and comply with, do I try and 
understand 15,000 pages of regulations and then pay $20,000 for a 
family plan--which is the new CBO estimate for a family plan in the 
year 2016. Do I do that or pay the $2,000 penalty?
  With ObamaCare, they are not exposing their employees to a financial 
risk. They are making them eligible for huge subsidies, $10,000, if 
they have a household income of $64,000.
  So I will throw it over to Senator Sessions on the Budget Committee. 
My concern is we are not even beginning to contemplate what the effects 
of that might be. What does the Senator think of that?
  Mr. SESSIONS. I couldn't agree more about the concerns the Senator 
raised.
  Senator Johnson was a successful businessman. He provided health 
insurance for his employees. He had to purchase it. I will just ask him 
one quick question. Based on his experience--a year and a half ago he 
was doing this business. What are the incentives for a business that is 
already in existence, providing health care, why might they not 
continue to provide it? Why might a new company, a startup company, a 
small business that hopes to grow and have hundreds of employees--why 
might they never start with employer-based health care?
  Mr. JOHNSON of Wisconsin. Again, it is becoming so complex. It is 
becoming so expensive. Again, the big difference ObamaCare throws into 
the equation is, in the past, responsible employers--and most employers 
truly care about the people who work with them--wouldn't have dreamed 
of exposing their employees to financial risk that would be obvious if 
they didn't provide health care insurance. But with ObamaCare, that is 
not what is happening. Now these exchanges will be available as well as 
huge subsidies.
  I am not aware of too many large Federal subsidies that go unused, 
and that is my concern. So the equation is totally different now. It is 
going to be totally different under ObamaCare.
  My question for CBO--I know they just conducted a study and did some 
sensitivity analysis, but they didn't go anywhere near far enough, from 
my standpoint. I think the largest number of employees they took a look 
at might have been 20 million individuals. But when we have 154 million 
Americans getting employer-sponsored care and the McKinsey study saying 
half of those, more than 75 million--I think we need to take a very 
serious look at what effect on our budget that would have.
  Mr. SESSIONS. I think all of us need to be listening to this because 
it is something that was not sufficiently considered during the debate; 
that is, that dramatically more employers may quit providing insurance, 
new companies that get started will not provide

[[Page 3564]]

it, people will be on the exchanges, and it will cost far more than was 
expected. That is an entirely new issue.
  Assuming the low numbers the Congressional Budget Office said will go 
into the exchanges, just taking the numbers they assumed, let me point 
out what Senator Kyl said. President Obama, in an exact quote to the 
joint session of Congress when he was promoting this legislation, not 
some off-the-cuff figure, said this:

       Now, add it all up. And the plan I'm proposing will cost 
     around $900 billion over 10 years--

  This was a deliberate attempt, as has been suggested, to manipulate 
the figures because the taxes started right away, but the spending was 
4 years delayed essentially, so we only have 6 years of spending under 
the plan. It also excluded many other provisions.
  For example, the bureaucratic implementation costs were not counted. 
The amount of effort, even the IRS will have to hire people who have to 
be involved, and this was not counted. New spending to close the 
Medicare doughnut hole. We didn't have the money in 2002 or 2003 to 
fund that provision. We have never been in worse shape. We are 
borrowing 40 cents of every $1 we spend, far worse than we were. Next 
year will be the fifth consecutive $1 trillion deficit. We don't have 
the money. So now we are spending more on that program that we don't 
have, the new or early retiree program.
  So once we add all the different provisions in the health care law, 
total gross spending over the original 10 years, when only 6 years is 
being paid for--over 10 years is actually 1.4 trillion. Those are the 
numbers we have. So this was a misrepresentation. This is from 2010 
through 2019, 1.4 trillion. But when we add all the costs over the 
first full 10 years of this health care bill, it will be $2.6 trillion.
  The point is, the bill is not good health policy. The American people 
oppose it overwhelmingly. Absolutely, we do not have the money. We have 
never had a more systemic death threat to America, and it is so painful 
to see this happen.
  I thank Senator Johnson for his energy, for the commitment he has 
brought to this issue. He has seen it on the other side, the real-world 
side, and he is helping to motivate us all to explain to the American 
people the dangers of the bill.
  Mr. JOHNSON of Wisconsin. I wish to ask Senator Sessions a question. 
We have talked about this in the past. I know a lot of people talked 
about the Medicare cuts being double counted, and I never quite 
understood exactly what that was. Can the Senator maybe explain a 
little bit to the American people what that means.
  Mr. SESSIONS. Yes.
  As a part of the funding for the ObamaCare legislation, there was an 
increase in Medicare taxes and a cut in Medicare benefits totaling $400 
billion. That money was used to fund the new health care bill by the 
U.S. Treasury, an entirely new program. But it is Medicare's money. It 
is not the Treasury's money. Medicare has trustees. Medicare loaned the 
money to the U.S. Treasury. It was borrowed money that was used to fund 
this bill, not money that came in new and free of charge. Since 
Medicare is going into default and going to claim its debt in a few 
years, the Federal Government is simply going to have to either raise 
taxes, cut spending somewhere else or, more likely, convert the 
borrowing from Medicare, borrow money on the open market from China and 
other places, and then pay Medicare back.
  It is, as the CBO Director told me in a letter, December 23, the 
night before we voted: You are double counting the money.
  No wonder this country is going broke. This isn't extra money. Half 
the original estimate of the bill, $900 billion, was funded by borrowed 
money from Medicare. This is how this country is surging in its debt 
and why we are in danger of the entire economy entering into collapse.
  Mr. JOHNSON of Wisconsin. Does the Senator believe those Medicare 
savings will actually be realized? Does the Senator believe Congress 
will actually enact those savings?
  Mr. SESSIONS. That is a good point, because in the past we have 
attempted and claimed we were going to make savings in Medicare and 
they never occurred.
  What I am saying is if these savings were to occur and if the new 
taxes on Medicare go into effect, as they are, that money is what is 
being used to fund an entirely new health care program. There is real 
doubt it will ever achieve those savings in Medicare, because if we 
keep cutting doctors and we keep cutting hospitals, they can't keep 
doing work. They will start refusing Medicare and Medicaid work. We are 
in that position already on some of the cuts that we rescind every year 
because we know the health care system would collapse if those cuts 
were to go into effect.
  Mr. JOHNSON of Wisconsin. That is one of my concerns. Let's say we 
actually do enact those cuts to Medicare and we don't reimburse 
providers and doctors in some cases to even cover their costs.
  I know this is hard to get to, but I have read where only 60 percent 
of providers are willing to see and treat Medicaid patients. Now what 
we are going to be doing is adding 25 million new individuals onto 
Medicaid rolls, where only 67 percent of providers are seeing those.
  I would ask Senator Boozman, because he is not only a new Senator but 
also a doctor and he ran a business, would he comment on that as well. 
I think he has some comments in terms of how this health care law will 
be affecting employment and jobs.
  Mr. BOOZMAN. I appreciate the Senator's leadership in this area. I 
also appreciate the fact that he jumped out and ran for the office and 
was elected, because we desperately need people such as Senator 
Johnson, people who were successful businessmen who understand the 
unintended consequences of much of what we do. I, similar to the 
Senator, also have a firsthand understanding of this issue from an 
employer's perspective and maybe a little bit unique perspective.
  Before I came to Congress, I practiced optometry and helped run an 
eye care clinic with my nine other partners for 24 years. So when 
President Obama's health care bill came before us when I was in the 
House, I fully understood, from both the medical provider and from the 
business aspect, that from both accounts, it was the wrong approach to 
the problem of rising health care costs and, with the Doctors Caucus in 
the House, worked very hard to highlight the problems and to also 
highlight the alternative options working through the free market 
approach.
  There is no doubt about it, we are facing a serious crisis. Health 
care costs are crippling Americans. Many Americans lack access to 
quality health care. It is stifling our Nation's overall economic 
development. There are real difficulties with physicians and hospitals 
that they face when it comes to accessibility and affordability of 
health care services. But despite all that, there is a right way and a 
wrong way to address the problem. The President's health care law is 
simply the wrong approach and the wrong answer.
  Coming with a pricetag of $1.75 trillion, the law causes many more 
problems than it solves. It is not lowering health care costs, as we 
are seeing. In fact, it is driving them up. It is not deficit neutral. 
It is a budget buster.
  Because of Medicare cuts, because of the way it is set up, it is 
going to lead to rationing and decreased quality of care. It will not 
help the economy. In fact, it is further stalling the recovery.
  On that note, specifically, the President's health care law makes it 
difficult for small business owners to hire more employees. At a time 
when our economic recovery continues to lag, the concerns over new 
mandates, confusing rules, and additional taxes in the law have small 
business owners rightfully concerned. Again, I can appreciate this in 
the sense of not only being an eye care provider, a health care 
provider, but somebody who had 85 employees.
  Far from getting jobs, as the President promised, it is estimated the 
law will actually result in 800,000 fewer jobs over the next decade. It 
is almost as if

[[Page 3565]]

the law was written with no input from America's small business owners 
and the health care providers that will run it.
  In the 24 years I was at our clinic in northwest Arkansas, we grew 
our staff from 5 employees to 85. My colleague from Wisconsin can 
attest to the fact that guiding one's business to the point where one 
can add personnel is not an easy task. It takes strategic planning and 
management, but it also takes an economic environment that allows small 
businesses to expand, invest, and hire. Instead of doing that, the 
health care law furthers the climate of uncertainty that our job 
creators already face.
  Small business owners are certainly hurting in this economy. They are 
worrying about tax hikes that Washington keeps threatening to force 
upon them. They see an enormous flood of regulations coming their way. 
Gas prices keep skyrocketing. Profits are way down as a result of the 
sluggish economy. There is so much uncertainty, what mandates will 
evolve from this health care law and ultimately what these costs will 
be for small business owners only adds to that unease.
  When interviewed, business owners said that the major concern that 
keeps them from hiring--and I have been out and about as much as 
anybody in the last 2 years, and this is exactly what I am hearing--is 
the uncertainty caused by the cost that they believe they will incur by 
the new health care law. We need to repeal and replace it with health 
care reform based on a free market system.
  Mr. JOHNSON of Wisconsin. I thank Senator Boozman. I think it is 
extremely important for us, in the next coming weeks and months, to 
paint a very accurate picture for the American people about what our 
health care system is going to look like, what our Federal budget is 
going to look like, the effect on American jobs and our economy, and 
the effect on our freedoms that we are going to witness if this health 
care law is fully implemented. I think it is critical we provide the 
American people that type of information.
  Of course I know Senator Roberts has some thoughts in terms of how 
this health care law will affect jobs and our economy. He has been very 
good at describing some of the nonsense regulations that are being 
undertaken by this administration. I want Senator Roberts to share his 
thoughts about what he thinks--paint us a picture of what is America 
going to look like under this health care law.
  Mr. ROBERTS. No. 1, I want to give the Senator a lot of credit for 
leading this colloquy in regard to where we are 2 years from the 
passage. It is hard to say what it is. Now it is ACA, the Affordable 
Care Act; it used to be PPACA, the acronym, which I thought was very 
appropriate. Of course if you politicize it, it is called ObamaCare. I 
don't mean to do that in this debate. But I do thank the Senator for 
focusing on jobs and costs.
  I thank Senator Kyl for a CBO truth. He ought to start a new program 
like the old show ``Truth Or Consequences.'' Senator Kyl pointed out 
the consequences. He pointed out the consequences, when you ask the CBO 
for a score when you are going to try to pass the bill, they will give 
you exactly what you want, but the truth is down the road it costs an 
awful lot more.
  There is one person you left out in terms of the CBO telling the 
truth and that is Richard Foster, who is the Actuary down at the 
Department of Health and Human Services. That man ought to get a Purple 
Heart, a Medal of Honor--not a Medal of Honor, just give him a Purple 
Heart and maybe a Bronze Star for action in the war zone and then maybe 
a Medal of Freedom later.
  Senator Sessions, who is our resident bulldog on the budget, hit it 
on the second counting. I thank him for that. That is a half trillion 
dollars. The other half of that is that it is a half trillion that goes 
to all these exchanges and the rules and regulations in setting up the 
Affordable Health Care Act. Basically, it denies Medicare reimbursement 
to all sorts of folks--doctors, nurses, hospices, pharmacists, 
ambulance drivers, hospital administrators--on and on. We had a health 
care summit in Topeka, KS, and 34 regulations popped out of the 
woodwork. We could have had 164 but we sent the 34 in to the Secretary 
of HHS. Then he went out to Hays, KS. That is really out there in the 
rural health care system. We had seven different regulations. I hope 
later when we have a colloquy on regulations we can certainly insert 
those into the Record.
  Senator Boozman, who is a physician, gave a standpoint of what 
happens in regard to rationing.
  Let met get Senator Boozman's attention for a minute. Do you know who 
enforces this thing, at the end of the year if you do not sign up, if 
you do not put on your tax return, which I assume it will be, in terms 
of what kind of coverage you have? It is the IRS. The IRS is going to 
be the enforcement entity in regard to whether you have a provider. If 
you do not, you get fined.
  Stop and think a minute about what is going on, and all the waivers 
that have been going on in terms of who is enforcing this. Your 
friendly Internal Revenue Service--what--reinforcer? I have a lot of 
feeling about this.
  I took the floor today to discuss something called promises made and 
promises not kept. I tell the distinguished Senator from Wisconsin, of 
all the words that come back to bite you, this one has. That is the 
famous statement prior to passage of the health care reform law by the 
President: ``If you like your health care plan, you can keep it.'' I 
will give him credit, he may have believed it then. But as we pointed 
out with Senator Kyl, Senator Sessions, Senator Boozman, Senator 
Johnson--that is not the case. I didn't believe it then and I said so. 
Neither did Senator Sessions. Neither did Senator Kyl. Those two are 
here now, taking a good look at it. They don't believe it either.
  Why? It is pretty simple. Employers and health care providers told me 
that when the majority of the provisions of the health care reform law 
would take effect, it would be more affordable for an employer to 
simply stop offering their employee coverage and pay a penalty rather 
than face the predictable increase in premiums and to continue to offer 
any coverage.
  Now these predictions have turned into facts. A new study just 
released by McKinsey & Co., a consulting company, predicts large 
numbers of workers will be shifted into the health exchanges in 2014. 
That is a shift that folks should be worried about--exactly what you 
are talking about, Senator Johnson. Literally thousands of regulations 
and waivers are pouring out of the Department of Health and Human 
Services; in fact, to date, 12,307 pages of additional regulations to 
restrict personal freedom and micromanage the private market.
  To make matters worse, there is the predictable worry that the 
exchanges would be better described as much like Medicaid HMOs. That is 
the kind of service we can expect to get and that threatens access, 
choice of doctors, and not to mention the rationing regime that will be 
the marching order of the day. I will have a lot to say about that in 
the colloquy in the next several days.
  At the time the President made his promise, the CBO estimated that, 
as Senator Kyl pointed out, only about 7 percent of employees covered 
by employer-sponsored insurance would make the switch, or be forced to 
switch, to taxpayer-subsidized exchanges. Now I tell the Senator, study 
after study is releasing facts and figures that find the health care 
reform law will cause many or even most employers to quit offering 
their current health insurance.
  In a survey by benefits consultants at Lockton, when asked about the 
cost of notifying employees of changes required by or resulting from 
health care reform law, they said each notification will cost $1 to $3 
per employee. Talk about cost. This would raise costs by tens of 
thousands of dollars or more for some firms and nearly one in five 
firms is considering terminating coverage outright, thanks to the law.
  With each study the numbers go up. The McKinsey survey found that 45 
to 50 percent of employers say they ``will

[[Page 3566]]

definitely or probably'' pursue alternatives to their existing health 
care plans. Even more alarming, some 30 percent of employers will 
simply stop offering any coverage. Those are the facts. There are more 
to come.
  I am going on too long here, I understand that. I simply say again I 
thank my colleagues. Contrary to this administration's seeming belief, 
there is no such thing as free health care. Somebody does pay. In this 
case the American taxpayers will be forced to foot the bill for workers 
whose employer-sponsored coverage has been dropped due to health care 
reform.
  There is another quote I wish to mention. It should be the subject of 
another colloquy. There is absolutely no rationing in this bill, it is 
just scare talk. Want to bet? There is nothing that hurts the truth 
more than stretching it. With PPACA or ACA or ObamaCare, jobs and costs 
will be stressed beyond the limit.
  I truly thank the Senator for sponsoring this colloquy.
  Mr. JOHNSON of Wisconsin. I appreciate the comments of the Senator. 
He mentioned rationing. What is the Independent Advisory Board for? Do 
you have a clue? To me that would somewhat lead, potentially, to 
rationing. I would be suspicious of that. Senator Kyl stood up here. He 
may have some additional comments.
  Mr. KYL. Yes. I would say when my colleague from Kansas talked about 
the free care, it reminded me of the old saw: You think insurance is 
expensive now, just wait until it is free. That is the point. Somebody 
has to pay for it at the end of the day, and we just happen to have 
some new statistics how this is working out now that CBO has had a 
chance to examine how ObamaCare plays out. Here is their newest 
estimate. We are talking about real costs to real families.
  CBO now estimates that ObamaCare will increase premiums by 10 to 13 
percent. To make that number real, that is a $2,100 annual increase in 
the cost for the average family of purchasing their own insurance 
coverage. Six separate private actuarial analyses have all indicated 
ObamaCare will increase premiums with projected increases ranging as 
high as 60 percent.
  Why is that so? It is like a balloon; you push in on one side, it 
pops out the other. Health care is still going to cost. Doctors still 
have to treat people, hospitals still have to take care, pay the people 
who work in the hospitals and so on. It is not free, as our colleague 
from Kansas is pointing out. Somebody has to pay for it. If the 
government cannot afford it, then what the insurance companies have to 
do is charge the extra expense to the people in the private insurance 
market.
  When the President complains about why insurance costs are going so 
high, he only has himself to blame. If the government is not going to 
reimburse the providers adequately, they have to get the money from the 
private sector. That is why the $2,100 annual increase in the cost of 
insurance for the average family, because of the cost shifting that is 
going on. It is a result of the way the government designs the 
insurance that is provided for in ObamaCare. It hits the young people 
especially hard because they are the ones who have to buy insurance 
they do not need, according to America's Health Insurance Plans. 
Premiums increase 48 percent for people between 18 and 29 years old. 
That is in only 42 of the 50 States, premium increases of 48 percent. 
Then of course they also tax health insurance, which we end up paying 
for because that cost is passed on to us in the form of higher 
insurance premiums. That is a $60 billion tax on health insurance added 
on top of the new taxes on innovation, on new pharmaceutical products, 
on new medical devices. The taxes that are included in ObamaCare on 
those are all passed on to consumers in the form of higher prices.
  The bottom line is we are paying for all this one way or the other, 
either through new taxes, through what we pay to the government, or 
through what we pay in our private insurance, because the physicians 
and hospitals have to make up the money one way or the other.
  The bottom line is that ObamaCare, which was supposed to have reduced 
costs, ends up increasing them. By the way, it was supposed to expand 
the numbers of people who are covered but now we find that, according 
to Milliman, which is a private association estimating the cost here, 
actuaries there have estimated the cost shift from government programs, 
Medicare and Medicaid, totals $88.8 billion a year, adding $1,788 to a 
family's insurance policy. That is on top of what I spoke of before.
  This cost shift obviously will greatly increase with ObamaCare's 
Medicaid and Medicare cuts, which are further on down the road here. 
That will cause premiums to skyrocket even more.
  The bottom line is that we were right when we said it: The law is 
going to drive up insurance premiums for families, it is going to drive 
up taxes, it is going to reduce innovation. At the end of the day, it 
doesn't cover more people. All in all, a great success, I would say.
  Mr. JOHNSON of Wisconsin. I remember back in Oshkosh, WI, President 
Obama famously promised: If you pass this health care law, the average 
costs per family would decline by $2,500 per year. That is one of those 
broken promises that Senator Roberts was mentioning earlier.
  Mr. ROBERTS. The Senator asked me about IPAB. It is not an iPad or an 
iPhone or whatever. I am sure Apple has nothing to do with it.
  Well, the administration, in response to a lot of concern about 
rationing, wrote an op-ed and sent it to many different publications 
and said, ``[T]he claims that the board will ration care are simply 
false.'' At the time, I repeated my concerns over and over again. 
Senator Kyl will remember those days in the Finance Committee. I think 
everybody left when I started my rant. And the health care reform law's 
potential to ration care--I made speech after speech--is not only IPAB; 
there is the CMS Innovation Center, the new authority granted to the 
U.S. Preventive Services Task Force, the Patient-Centered Outcomes 
Research Institute, and finally IPAB, and that is not a toothpaste.
  At the time, the American public was told over and over that these 
provisions of the health care reform law would not result in the 
rationing of care, loss of access, or reduced quality. But once again 
the Medicare Actuary, Richard Foster--bravest man in the government--
and many others have noted that the kinds of payment reductions 
contemplated by IPAB will amount to a de facto rationing by reducing 
access to care. The Actuary has stated that the payment reductions in 
the law could ``jeopardize access to care for beneficiaries''--senior 
beneficiaries. He also predicted that the IPAB reductions in particular 
would be difficult to achieve in practice because of the access-related 
harm to seniors that would result. That is IPAB for you.
  Mr. JOHNSON of Wisconsin. Earlier Senator Roberts mentioned the U.S. 
Preventive Services Task Force. Wasn't that the agency that proposed 
denying women mammograms until they reached the age of 50?
  Mr. ROBERTS. That is correct. For every proposal like that, thank 
goodness there has been a reaction by the public and the medical 
profession and everybody else to say: Wait a minute, this doesn't make 
any sense. Again, it is an agenda-oriented board or commission or 
whatever that comes under the banner of rationing.
  I have a wonderful chart I will show to you in the next colloquy in 
regard to the four rations--and one was just mentioned--and then ask me 
about IPAB. They are a little benign. I am going to have to change the 
caricatures. They are like the four horsemen of the apocalypse in 
regard to the health care system of the United States. As you look at 
each one of them and what they are doing, they are rationing care. They 
are rationing care.
  Mr. JOHNSON of Wisconsin. If this is implemented, we are just 
beginning to see the tip of the iceberg of the assault on our freedom 
that this is going to represent.
  Mr. BOOZMAN. I think this rationing is such an important situation. 
We

[[Page 3567]]

are already seeing rationing right now. As an optometrist more than 
being a Senator, I get calls all the time from people who have moved 
into town and they can't find a health care provider for their aunt or 
uncle who is in the Medicare age group. Physicians are definitely 
cutting back because of the payment plan.
  Seniors are smart enough to figure out that you can't add 30 percent 
more patients under this plan, and along with that, there is no 
increase in physician fees, no increase in the infrastructure required 
to take care of them. Something has to give, and that is going to be 
two things: quality of care and rationing.
  The same thing is true of Medicaid. In Arkansas, we are going to have 
to increase our Medicaid rolls by 250,000 people. Our State only has 3 
million people to begin with. Again, something has to give. How do you 
pay for that? The reality is that will cost us in the neighborhood of 
$400 million. Where will that come from? It will come from providers. 
It will come from decreased funding for education, roads, and things 
like that. Again, you can't do this without rationing and 
consolidation.
  Mr. JOHNSON of Wisconsin. I think the bottom line of this health care 
law is that it is basically going to increase demand while at the same 
time reducing supply, and that is not a good thing. It is certainly not 
the way you bend the cost curve down.
  I understand Senator Sessions has a few more comments.
  Mr. SESSIONS. Senator Kyl and the Senator from Kansas, as he has 
indicated, were engaged in this cost curve-bending plan. The essence of 
the President's proposal--it went to the core of other proposals 
financially--was that by a Federal Government expansion of our 
authority, we would bend the cost curve and make health care cheaper 
for all Americans. That was a fundamental principle that was sold to 
businesspeople, and some businesspeople thought it was a great idea, 
but it has not happened. Already the premiums in private health care in 
America have gone up $2,000, almost $200 a month, and we are going to 
see it continue to go up. It does not bend the cost curve down. In 
fact, we are seeing the opposite occur.
  We have to know that our per-person government debt--Senator Johnson 
is on the Budget Committee, and he knows this--is worse than any other 
Western world nation. Per capita, we have more debt than Greece, Spain, 
Italy, and Ireland, with $44,000 per person that every man, woman, and 
child owes. And if the President submitted a budget and if it were to 
be enacted--and certainly it will not be--that would go to $75,000 per 
person in 10 years.
  This health care bill is dramatically adding to that. Every expert we 
have had at the Budget Committee has told us that we are on an 
unsustainable spending and debt path that will lead to financial 
collapse. Erskine Bowles and Alan Simpson, who chaired President 
Obama's debt commission, both issued a written statement that America 
has never faced a more predictable financial crisis. What they told us 
was that spending and running up debt as we are today guarantees a 
financial collapse that could impact every person in America and deeply 
impact our ability to have health care in this country.
  So I think we have to recognize that the Republican-controlled House 
of Representatives will unveil a budget plan tomorrow. The Senate is 
not going to bring up a budget. The Democratic leader said it is 
foolish to have a budget, so we will go for the third consecutive year 
without even attempting to pass a budget. It is supposed to be out of 
the committee by April 1. It is supposed to be passed by April 15. The 
House is going to do it. They are going to step up to the plate, and 
they are going to lay out a plan like they did last year, a plan that 
will change the debt course of America, a plan that would put us on a 
sustainable path so that we don't have to fear financial collapse.
  They are going to look at this legislation, and it cannot be imposed. 
We do not have the money. It is going to make health care worse, as we 
have heard, but more than that, we simply--even if it were a good idea, 
a nice thing to have, we do not have the money. We are borrowing 40 
cents of every dollar we spend, and they misrepresented the cost. It is 
far higher than anyone has expected, and it is going to continue.
  For example, our people have looked at the CBO score--on the Budget 
Committee--and they have analyzed it fairly, and I am prepared to 
defend these numbers. Based on CBO's scores, from 2014--the first year 
the law is really in effect--until 2023, it will cost $2.66 trillion. 
It is far more than was projected. How much money is that? Over the 
same 10-year period, we would spend $626 billion on Federal highways. 
We had been fighting over highways, and we finally passed a highway 
bill. The Federal money for the whole highway system would be $626 
billion, while we are adding a new program that is improperly funded 
for $2,600 billion. Over the next 10 years, we expect to spend $1,000 
billion for education, and this health care cost is going to be $2,600 
billion. We have disasters. We spend a lot of money on disasters. It is 
expected that we will spend $111 billion on disasters, whereas we will 
spend $2.6 trillion on the health care bill.
  This is the kind of thing that has the American people asking us: Are 
you crazy? How can you borrow 40 cents of every dollar you spend, as we 
are doing today. How can you do that to America? What is the matter 
with you people?
  They say people back home are not smart, they are just angry. Well, 
aren't they right to be angry? We are adding a program that is 
financially unsound, that is going to make health care worse, and we 
don't have the money. This money needs to be used to save Medicare and 
Social Security--programs that are already in great jeopardy. If we 
have money, we have to use it to save them, not start a new program of 
massive proportions that, over 60, 75 years, is going to cost far more 
than anyone imagines.
  I thank Senator Johnson for raising this, and I am concerned about 
the costs. I know Senator Boozman and others have talked about the 
rationing. There are a lot of reasons why we simply can't go forward 
with this health care bill. It must be eliminated as we know it. We can 
make reforms, but this legislation cannot go into effect.
  Mr. JOHNSON of Wisconsin. I certainly appreciate Senator Sessions' 
comments and those of Senator Roberts, Senator Kyl, and Senator 
Boozman.
  There are two points I would like to make. It is important to 
understand that all these numbers we are talking about are estimates. 
The Federal Government is not particularly good at making those 
estimates because if you think back to 1965 when they first passed 
Medicare, they projected out about 25 years and said that in 1990 it 
will cost $12 billion. In fact, it ended up costing $110 billion--nine 
times the original cost estimate.
  The other point you were making is, Does it make sense for the 
Federal Government to take over one-sixth of our economy? When I went 
back to Wisconsin, I asked that question of thousands of individuals. 
Do you really believe the Federal Government can take over one-sixth of 
our economy--the health care sector--and do it effectively and 
efficiently? I asked that to thousands of people. I have had two brave 
souls raise their hands. The fact is, the American people do not 
believe the American Government is capable of doing that.
  In closing, I would like to remind everybody what Speaker Pelosi very 
famously said: We have to pass this bill so we can find out what is in 
it.
  I know Senator Sessions and Senator Boozman are dedicated to making 
sure we don't have to fully implement the health care law before we did 
figure out what it truly costs us because it could bankrupt this 
Nation.
  I yield the floor.
  The PRESIDING OFFICER (Mr. Coons). The Senator from Connecticut.

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